CBD and the contraceptive pill (e.g. Valette, Diane-35, Yasminelle)
David ReichUpdated:Key points at a glance:
CBD may interact with hormonal contraceptive pills. This is thought to be linked to an effect on liver enzymes such as CYP3A4 and CYP2C19. Products containing ethinylestradiol and progestins like drospirenone, dienogest or norgestimate are often mentioned in this context. The potential for interaction may increase with higher doses and when other medications are taken at the same time. When starting CBD or changing the dose, using additional contraception for 2 to 4 weeks is often recommended as a precaution. Possible warning signs of altered pill effectiveness can include breakthrough bleeding, changes in the menstrual cycle, pronounced nausea or breast tenderness.
Does CBD affect my contraceptive pill? This is a question we hear frequently. An interaction is theoretically possible, mainly via liver enzymes that are involved in the breakdown of both CBD and pill hormones. Here you can find out what this could mean for you, which pills may be affected, and how you can practically minimise potential risks.
Does CBD influence the effectiveness of the contraceptive pill?
Cannabidiol (CBD) can inhibit liver enzymes that are also involved in the metabolism of many combined hormonal contraceptives (ethinylestradiol + progestin). Two effects are therefore conceivable: a) hormone levels may rise – side effects could become more likely; b) with high CBD doses and more complex interactions, the reliability of contraception may be harder to predict. Clinically relevant effects are mainly considered at higher CBD amounts and in the presence of pre-existing liver problems. Caution is therefore advisable.
CBD may inhibit the liver enzymes that break down many pill hormones. This can alter hormone levels. Evidence is limited and based mainly on CBD effects on CYP3A4/CYP2C19, so if in doubt, use additional contraception.
Briefly explained: liver enzymes (CYP3A4) and CBD metabolism
CBD is metabolised in the liver in part via CYP3A4 and CYP2C19 and may inhibit these enzymes. Many pill components (ethinylestradiol and progestins such as drospirenone, dienogest, norgestimate) are also metabolised via CYP3A4. If this enzyme is inhibited, the body breaks down the hormones more slowly – blood levels can rise. At very high CBD doses or when other CYP3A4‑active substances are taken at the same time, effects are more likely. Usual doses of over‑the‑counter CBD products are generally considered to carry a lower risk, but product quality, cumulative intake and individual sensitivity may still play a role.
Which contraceptive pills may be affected by CBD?
| Pill ingredient | Class of substance | Metabolism | Possible effect with CBD | Evidence |
|---|---|---|---|---|
| Ethinylestradiol | Oestrogen (combined pill) | CYP3A4 | Levels ↑, side effects ↑ possible | Theoretical, limited data |
| Drospirenone | Progestin | CYP3A4 | Possible changes in levels | Theoretical |
| Dienogest | Progestin | CYP3A4 | Possible changes in levels | Theoretical |
| Norgestimate | Progestin | CYP3A4 | Possible changes in levels | Theoretical |
Progestogen‑only pills (e.g. desogestrel) are also metabolised; the data on CBD in this context is even more limited. Non‑hormonal contraceptive methods (condoms, copper coils) are not affected by this type of CBD drug interaction.
How are CBD and the pill broken down in the liver (CYP3A4)?
CBD and many pill hormones use the same “metabolic pathway” in the liver. Prescription CBD medicines (such as Epidyolex) have been shown in studies to inhibit CYP3A4 and CYP2C19 in a dose‑dependent manner – clinically relevant effects were mainly seen at higher doses (5–20 mg/kg/day). Over‑the‑counter CBD oils and capsules are usually taken at lower doses; nevertheless, individual differences, product quality and combinations with other prescription medicines need to be taken into account.
CBD and pill hormones share liver enzymes such as CYP3A4. The higher the CBD dose and the more other CYP3A4‑active medicines you take, the more likely interactions with your contraceptive pill may become.
What does the current research say about CBD and the contraceptive pill?
Direct evidence on “CBD and the contraceptive pill” is limited. Most statements are based on known metabolic pathways (CYP3A4/CYP2C19), pharmacological data and experience with prescription CBD medicines. Clinically relevant effects have mainly been observed at higher CBD doses and/or where liver enzymes were additionally stressed. For typical over‑the‑counter CBD doses, there is currently no robust evidence of contraceptive failure – but it cannot be completely ruled out.
Professional bodies and authorities generally advise caution when CBD is used together with medicines that are metabolised via CYP3A4/CYP2C19. This is particularly important if other interacting substances (e.g. certain antifungals or anticonvulsants) are being taken or if there is an existing liver condition.
Read our article here on CBD and interactions with medicines.
Practical tips: how to minimise your risk
CBD and prescription medicines can interact in complex ways. If you use CBD alongside the pill (for example Yasminelle, Valette, Diane‑35 or similar preparations), cautious use and monitoring are sensible.
- Start with a low CBD dose and increase slowly; avoid high doses without medical advice.
- Use an additional barrier method (e.g. condoms) for 2–4 weeks after starting CBD or changing the dose.
- Keep a brief symptom and cycle diary (bleeding pattern, side effects) during this period.
- Watch out for possible warning signs: breakthrough bleeding or changes in your cycle, severe nausea or breast tenderness, new migraine with aura.
- Contact your doctor if you experience persistent side effects, heavy intermenstrual bleeding, migraine with aura, or if you feel unsure about your contraception.
- If you have a liver condition or are taking other CYP3A4‑interacting substances (e.g. certain antifungals, anticonvulsants, or St John’s wort), seek individual medical advice before using CBD.
💊 Medication Finder
We have analysed the interactions between CBD and 140 medications und Medikamentenarten analysiert. You can view the full overview here or use the search below to find your specific medication.
CBD, grapefruit & enzymes – the analogy
Grapefruit inhibits CYP3A4 in a similar way to CBD. This is why many medicines come with a warning about grapefruit. CBD does not act identically, but the analogy can be helpful: if a medicine carries a grapefruit warning, particular caution is also advisable with CBD.
Pregnancy and breastfeeding
CBD is not recommended during pregnancy and breastfeeding. If you suspect you may be pregnant (for example after breakthrough bleeding or a missed pill), stop taking CBD and seek medical advice. Emergency contraception may be an option – speak to a healthcare professional.
Liver & blood tests
In studies with high‑dose CBD, increases in liver enzymes (transaminases) have been observed. If you have abnormal liver test results or an existing liver condition, you should only use CBD after consulting a doctor and be alert to symptoms such as pronounced fatigue, nausea or yellowing of the skin.
Be especially cautious with CBD in pregnancy or breastfeeding and if you have liver problems. If you are unsure: review your CBD dose, use additional contraception and seek medical advice.
Side effects at a glance
Side effects of CBD
CBD is generally considered to have a favourable tolerability profile. Commonly reported side effects include tiredness, dry mouth, dizziness or gastrointestinal complaints (such as nausea or diarrhoea). Changes in appetite are also possible. Potential risk can be reduced by using high‑quality products, cautious dose adjustment and medical guidance – especially if you are taking other medicines that are metabolised via liver enzymes.
Side effects of the contraceptive pill
Common side effects include nausea, breast tenderness, headaches, mood changes and breakthrough bleeding. Rare but serious events include blood clots (thrombosis). Seek urgent medical help if you notice warning signs such as sudden pain in the legs or chest, shortness of breath, visual disturbances or severe, unusual headache.
Many side effects of CBD and the pill are mild, but there are important warning signs (for example severe headache, leg or chest pain, yellowing of the skin) where you should seek medical help immediately.
Brands & active ingredients
- Yasminelle = drospirenone + ethinylestradiol
- Valette/Maxim = dienogest + ethinylestradiol
- Diane‑35 = cyproterone acetate + ethinylestradiol
- Ortho Tri‑Cyclen = norgestimate + ethinylestradiol
Note: Brand names vary from country to country – the decisive factor is the combination of active ingredients listed on the pack.
Conclusion
CBD and the contraceptive pill may interact via liver enzymes such as CYP3A4 and CYP2C19. The available data is limited, but caution is particularly advisable with higher CBD doses, additional medication and liver conditions. By increasing the dose slowly, monitoring your cycle and using additional contraception during the adjustment period, you can use CBD in a more informed way and help to minimise potential risks. If in doubt, seek medical advice.
Related posts
Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.